Obesity; although it is ignored by some of us, it is quite common and is the health problem in the background of most of its common diseases. Intervention in this problem is vital, for which it is possible to benefit from the advanced instruments of modern medicine. Obesity surgery or weight loss surgery or stomach reduction surgery, by definition among the public, is the general name of the methods used to treat obesity. İntragastric balloon or Intraintragastric balloon with medical name; is one of these surgical applications and one of the new generation effective types.
İntragastric balloon; it is a low-complication method that allows the patient to lose weight effectively in a short time, and research has shown positive reports that patients lose weight.
Obesity can give rise to many health problems, including cancer. The available data and clinical research show that it is a much more effective method to solve the problem at its source by treating obesity, rather than fighting diseases caused by obesity.
Since it is accepted that people face serious health risks at the level at which the obesity surgery requirement arises, it is imperative that all necessary practices are preferred for the treatment of this health problem. Of course, the surgeondecides which method to perform in what way and the necessary protocols are preferred in the light of medical protocols.
What is Intragastric Balloon?
İntragastric balloon; it is a synthetic implant in the form of a balloon. This balloon, which is inserted down to the stomach by endoscopically, can be filled with liquid or air. This application, which is based on the principle of reducing its capacity by creating an undigestible area in it, not in the form of reducing stomach volume, can be used for a period of six months or one year and is removed in the same way it is inserted at the end of the period.,
The intragastric balloon is produced from a synthetic (silicone) substance and its strength is quite well. This apparatus has a type filled with liquid and a type that is filled with air. Both types can be preferred. Balloons, which have a volume of about 700cc and have the ability to be set (adjust) at intervals, remain in the stomach for a year and often do not cause any complications. Rarely, there may be leaking situations, in which case the problem is eliminated by intervening endoscopically of balloon removal.
History of Intragastric Ballon Surgery
In 1985, intragastric balloon entered our lives as a weight loss appliance approved by the U.S. Food and Drug Administration (FDA). In 1987 and 1988, practices of this application as a medical practice began, and in 1992 it became open to discussion due to some side effects. The method, which was completed in 2015 and obtained a license from the U.S. Medical Tool and Drug Administration with today’s application format, is currently used as a medical protocol in almost every country in the world. In fact, the country where balloons are produced most intensively is France, a European country.
How Intragastric Balloon Applicaton is done?
The balloon is applied endoscopically, i.e. without surgery. Since the patient is sedated with anesthesia, he/her does not feel anything during the procedure and the procedure is completed in an average of 15-20 minutes. Before the balloon is applied, the esophagus, stomach and duodenum are examined endoscopically and it is shown whether there is an contraindication to the application of the balloon. In patients who don’t have any contraindication, after the endoscope is removed, the balloon is inserted to the stomach through the mouth and esophagus. Then, after the position of the balloon in the stomach is clarified by performing endoscopy again, the balloon is inflated by giving the serum physiologically dyed with methylene blue into the balloon through special endoscopic apparatus. First of all, the serum given 400 cc can be increased over time according to the tolerance of the physiological patient and all these procedures are performed endoscopically. After the procedure, the patient immediately wakes up and is discharged to his/her home after being hospitalized for about 1-2 hours.
İntragastric balloon application is carried out by the surgeon in a clinical setting. There are no other forms of this application. In addition, the application is not made to everyone who requests it. A preliminary examination and, if necessary, a detailed consultation may be required for this. Therefore, it is most appropriate to contact the surgeonbefore choosing a treatment and ask for the most appropriate treatment method to be shown for you. The surgeon will determine the procedure required for you and will be able to perform it in a healthy way. It is important to remember that all medical procedures are the decision, authority and responsibility of surgeons. However, surgeons also decide and process depending on universal medical protocols.
How to lose weight with Intragastric Balloon?
A intragastric balloon is not a weight-loss drug or a tool that accelerates energy burning. This appliance reduces the ingested food capacity of the stomach, preventing the person from consuming too much food. Since the person does not have any incision or similar conditions in his/her stomach, it is possible for the person to return to normal life in a short time and thus immediately reach the level of calorie burning required by his daily life. With this being said, the intragastric balloon is a method with less exercise restriction unlike other weight loss surgeries. In this way, it is possible for the person to do certain sports, so the weight-loss process can be accelerated according to the situation.
However, it is very difficult to talk about a spontaneous weight loss process after the intragastric balloon procedure. Although the amount of nutrients that the person will consume at a time is decreasing, the result may be lower than expected if the total daily calorie intake is not reduced and the types of nutrients consumed are not suitable for the diet that the surgeon will follow.
It is mandatory for the person to complete his/her daily exercises after the procedure and consume the appropriate nutrients at the appropriate meals. However, in this way, it will be possible to achieve success in this operation as in all obesity surgery operations. In addition, regular visits to surgeons and dieticians are necessary for the process to continue smoothly.
For whom it is applicable?
Patients with BMI around 30 kg/m2 or with 15-20 kilos exceeding
Patients who fail despite many dietary and exercise programmes
Obese patients where surgical treatment is risky
Patients older than 18 and under 60
The authority of the decision to perform the intragastric balloon procedure belongs to the Surgeon. At this point, it is not the only condition that the person is physically fit for this procedure. As a result of the consultation, the surgeon may ask the person to follow a diet first. Therefore, being within the above criteria will not mean that you may receive this application unconditionally. In addition, although in some cases they meet these conditions, there may also be obstacles to receiving the application for various reasons. Therefore, it is not possible to make a definitive judgment on this issue before the doctor’s check-up.
For whom it is inapliciable?
- Alcohol and drug abusers
- Patients who are pregnant and those with pregnancy plans
- Those with severe heart, kidney, liver and lung diseases
- Patients who had esophagus and gastric surgery before
- Patients who have to use blood thinners continuously
- Patients with hiatal hernia and reflux
- Patients with peptic ulcer, gastritis and duodenitis
Outside of these conditions, those with obesity problems above a certain level, if they want have a intragastric balloon applied to them, they may be required a diet program first for a certain period of time. After the doctor’s checks, a clear answer is surely reached. Other diseases and medications used are among the factors that can be considered as obstacles.
Suitable for people at what age?
Intragastric balloon method is suitable for adults. Here the age limit is 18-60 years. However, depending on the situation, the age limit can be stretched from 16 to 75. As we have indicated in the topics of who can get intragastric balloon treatment and who can’t, suitable changes can be made in age groups by taking into account the condition of obesity and its effects on the person.
Obesity surgery for early ages is not widely preferred. Even diets for children who are in development age are elements that should be applied very carefully, therefore performing such an operation can be considered a risk. However, if obesity becomes larger than other risks, the age limit of this application can be lowered slightly by conducting detailed analyses.
Since nutrition is extremely important in older ages, stretching the age limit is a decision that can be made with the analysis to be made. Certain stretches may be possible if the doctor confirms its suitability and that there are no problems in terms of other factors.
What are the advantages?
The main advantage of intragastric balloon is that it is easier than other obesity surgery operations and carries a less risk of complications to the patient. The application is performed endoscopically and can be reversed at any time. In this respect, immediate intervention is possible in case of a side effect. Due to the fact that it is not a permanent implant, it does not have any effect on the body, it just remains in the stomach during the weight-loss process and does not cause an effect. It is a more convenient solution for those with stomach diseases, the effects at this point can be more easily controlled.
Of course, the most important feature of intragastric balloon is that it is more economical than most other applications. The operation ends in minutes and the patient returns to his daily life in a very short time, which may cost less for this application.
What are the risks and complications?
Although very rarely there may be bleeding and perforation of the esophagus and stomach when inserting balloons. At first, a feeling of discomfort, nausea and/or vomiting may occur in the stomach. Such conditions are controlled by drugs given both orally and intravenously, and over time the patient adapts to the balloon. Again, fatigue and tiredness may be due to decreased daily fluid intake in the first weeks. As a result of the perforation of the balloon, it escapes through the intestines and can cause a bowel obstruction that requires surgery.
Spontaneous intragastric balloon perforation is very rare. When it explodes, the blue water in it enters the intestinal tract and paints urine turns to blueish-green. In this case, the patient gets rid of the balloon thorough the or with the help of an endoscope down to his stomach, the balloon is removed without surgery.,
Although it is known that the complication rate is quite low, if there is an unexpected effect after this application, the doctor should be consulted in no time. The appearance of an unusual situation other than those indicated by the surgeon may indicate a different problem or a side effect related to the operation. If you consult a physician, the problem can be solved.
Recovery process after the procedure nutrition after the surgery
After the intragastric balloon procedure, the diet programme is started to special conditions for the first few days. The patient should not over-tire his stomach during the first week when complications are likely to occur. Since spasms may appear when the balloon settles in the stomach, liquid nutrition is a more accurate approach in the first 3 days. In the following time, the diet may gradually return to normal.
The most important element here is the necessity that the person does not try to eat as much as in the amount before he got the balloon applied to him. For example, If you consume 500gr of food per meal before the balloon, you should eat with the awareness that this should decrease after the balloon. If you do not reduce the amount of consuming nutrients at once and choose the way to eat the same amount, serious complications may occur, as the balloon will not allow it. Since your stomach will not be able to take the old amount of food, excessive bloating may occur. If this condition is maintained, this treatment will become ineffective, which means that you can not lose weight.
It will be necessary to pay much attention to the consumption of foods after this process. Excessive fatty foods, carbohydrate-heavy foods and acidic beverages should be consumed carefully for a certain period of time. Your eating habit should already be under control, as you will also already follow a diet in the process of losing weight.
You need to follow-up the plan that your doctor and/or dietitian will prepare for you to the letter. This system is a component of the process and should not be broken. With the right diet, you can lose weight in a healthy way within the planned period by taking this supplement treatment. It should not be forgotten that all obesity surgery operations allow you to lose weight at the end of a process, and a conscious and systematic diet has an important place in this process.
Excercises reccomended for those who get Intragastric Balloons
Exercises after intragastric balloon procedure are similar to other obesity surgical operations. However, the person who gets a intragastric balloon here should pay attention and not forget that there is an implant in the stomach. You should avoid any sport in which your stomach will be hit and be careful when doing sports such as heavy-lifting and/or boxing sports during the application period.
But that doesn’t mean you shouldn’t do any sports. On the contrary, sports, at least regular exercise and physical education are extremely important during the weight loss process. You should exercise appropriately and avoid heavy sports and prefer non-heavy sports, with a focus on jogging or running.
At a time when you are still fighting against obesity with the desire to lose weight as a moment, doing heavy sports is a risk not only in terms of balloons in the stomach, but also in terms of other functions of your body. Therefore, do not act without the approval of your doctor about the sports you will do. At this point, the decision maker is not any gym coach, but a doctor and dietician. You must follow this rule, as it can be extremely dangerous to do sports regardless of what your current situation may lead to.
If you exercise properly and eat correctly, you can lose weight with this method. Never abandon medical protocols to achieve a healthy process under the supervision of your physician.
1 Saber AA, Shoar S, Almadani MW, Zundel N, Alkuwari MJ, Bashah MM, Rosenthal RJ (2017). “Efficacy of First-Time Intragastric Balloon in Weight Loss: A Systematic Review and Meta-analysis of Randomized Controlled Trials”. Obesity Surgery. 27 (2). ss. 277–287. doi:10.1007/s11695-016-2296-8. PMID 27465936.
2 Metabolik Cerrahi Nedir? Türkiye Metabolik Cerrahi Vakfı (Web Siyafası URL: http://www.mecev.org/metabolik-cerrahi/) (Erişim tarihi: 27.08.2020)
3 Türkiye Metabolik Cerrahi Derneği (Web Sayfası URL: http://metabolikcerrahidernegi.org.tr/metabolik-cerrahi/)
4 Morbid obezite tedavisinde intragastrik balon uygulaması sırasında meydana gelen balon rüptürü vakası AKADEMİK GASTROENTEROLOJİ DERGİSİ, 2007; 6 (2): 94-96
5 Mathus-Vliegen EM, Tytgat GN. Intragastric balloon for treatmentresistant obesity: safety, tolerance, and efficacy of 1-year balloon treatment followed by a 1-year balloon-free follow-up. Gastrointest Endosc. 2005; 6: 19-27.
6 Intragastric Balloons for Obesity Management Web Sayfası URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763559/
7 A history of intragastric balloons Web Sayfası URL: https://pubmed.ncbi.nlm.nih.gov/26775045/
8 Intragastric Balloon Treatment for Obesity: Review of Recent Studies Web Sayfası URL: https://pubmed.ncbi.nlm.nih.gov/28707286/
9 Endoscopic Bariatric Therapy: A Guide to the Intragastric Balloon Web Sayfası URL: https://pubmed.ncbi.nlm.nih.gov/28707286/
10 Türkiye Metabolik Cerrahi Derneği (Web Sayfası URL: http://metabolikcerrahidernegi.org.tr/metabolik-cerrahi/)
11 Gaur S, Levy S, Mathus-Vliegen L, Chuttani R (2015). “Balancing risk and reward: a critical review of the intragastric balloon for weight loss”. Gastrointestinal Endoscopy. 81 (6). ss. 1330–6. doi:10.1016/j.gie.2015.01.054. PMID 25887720.
12 Gastric Perforation as a complication of intragastric balloon Web Sayfası URL: https://pubmed.ncbi.nlm.nih.gov/29475822/
13 Intragastric Balloons for Obesity Management – Web Sayfası URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763559/
14 Türkiye Metabolik Cerrahi Derneği (Web Sayfası URL: http://metabolikcerrahidernegi.org.tr/metabolik-cerrahi/)